M. Schaufelberger et al., SKELETAL-MUSCLE CHANGES IN PATIENTS WITH CHRONIC HEART-FAILURE BEFOREAND AFTER TREATMENT WITH ENALAPRIL, European heart journal, 17(11), 1996, pp. 1678-1685
To evaluate if enalapril treatment can influence skeletal muscle metab
olism and histology we investigated 26 patients with congestive heart
failure and 20 normal subjects. The patients were treated with enalapr
il for 3 months in addition to diuretics and digitalis. Biopsies from
the lateral vastus muscle were taken before and after treatment. Citra
te synthetase, 3-hydroxyacyl-CoA dehydrogenase and phosphorylase activ
ities were significantly decreased in the patients compared with contr
ols. The number of capillaries per fibre and the number of capillaries
surrounding each fibre were significantly decreased among patients. A
fter 3 months of enalapril treatment functional class improved signifi
cantly. The lactate dehydrogenase activity increased whereas the oxida
tive enzymes did not change significantly. The type I, II and IIA fibr
e areas increased significantly after enalapril treatment. We conclude
that patients with chronic heart failure have decreased activity of o
xidative enzymes and of phosphorylase in skeletal muscle. They also ha
ve decreased capillarization in skeletal muscle. These changes were no
t influenced by enalapril treatment,The increase in muscle fibre area
seen after enalapril treatment could be due to increased physical acti
vity. The cause of increased muscle lactate dehydrogenase activity aft
er enalapril treatment needs further investigation.